The invention relates to the subject that is characterized in the claims, i.e., the use of metal complexes that have a plasma protein bond of at least 10% as imaging diagnostic agents for locating an infarction or a necrosis based on the persistent accumulation of substances in the infarction or necrosis area.
Detection, location, and monitoring of necroses or infarctions is an important area in medicine. Myocardial infarction does not immediately result in irretrievable, non-functioning tissue; rather, it initiates a dynamic process that extends over a prolonged period (weeks to months). The disease proceeds in about three phases, which overlap rather than being distinctly separated from one another. The first phase, the development of myocardial infarction, comprises the 24 hours after the infarction, in which the destruction progresses like a shock wave (wave front phenomenon) from the subendocardium to the myocardium. The second phase, the already existing infarction, comprises the stabilization of the area in which the formation of fibers (fibrosis) takes place as a healing process. The third phase, the healed infarction, begins after all destroyed tissue is replaced by fibrous scar tissue. During this period, extensive restructuring takes place.
Up until now, no precise and reliable process has been known that would make it possible to diagnose the current phase of a myocardial infarction in a living patient. For evaluating a myocardial infarction, it is of decisive importance to know the extent of the portion of tissue that is definitively lost in the infarction and at what point the loss took place since the type of treatment depends on this information.
Infarctions occur not only in the myocardium but also in other tissues, especially in the brain.
While infarction can be healed to a certain extent, in the case of necrosis, locally limited tissue death, only the harmful sequelae for the rest of the organism can be prevented or at least mitigated. Necroses can develop in many ways: due to injuries, chemicals, oxygen deficits, or radiation. As with infarction, knowing the extent and nature of a necrosis is important for further medical treatment.
It is known that infarction and necrosis can be represented by antibodies that are directed against biomolecules that occur intracellularly and by porphyrins, metalloporphyrins and their derivatives. Antibodies and porphyrins can be produced only at great expense, however, and are problematical in terms of handling and compatibility in several respects.
It has now been shown that, surprisingly enough, metal complexes that have a plasm protein bond of at least 10% are suitable as imaging diagnostic agents for locating necroses that are produced by infarction or caused in some other way. In this case, the basic advantage consists of a persistent positive (bright) dyeing of necrotic areas with little to no signal enhancement of the environs. Non-protein-bonded, otherwise comparable complexes lead for only a short time to signal enhancement of well-perfused tissue, whereby underperfusedxe2x80x94even vitalxe2x80x94tissues remain unaffected. The blood supply to the tissues can also be detected using T2 or T2-star (susceptibility) effects, but differentiates non-vital from necrotic tissue. The plasma protein bond is, as is familiar to one skilled in the art, determined by equilibrium dialysis.
Preferably suitable are metal complexes that have a plasma protein bond of at least 50%, especially preferably of at least 80%. The metal complexes according to the invention have a molecular weight of at least 350 Da, and preferably at least 400 Da.
They have a T1-relaxivity of at least 2.0 [sxe2x88x921mMxe2x88x921], measured at 37xc2x0 C. and 20 MHz in plasma (see, e.g., Chem. Rev. 1987, 87, 901). Their stability constant is at least 1015 (logK=15).
The metal complexes according to the invention are metal derivatives of, e.g., polyaminopolycarboxylic acids, polyaminopolyphosphonic acids, porphyrins, texaphyrins, sapphyrins, peptides and their derivatives, as they are described in, e.g.,
If the metal complexes according to the invention are used for NMR diagnosis, the metal must be paramagnetic. This can be an element from the series of transition metals or lanthanides. Suitable ions include those of the elements iron, manganese, gadolinium, and dysprosium.
If the metal complexes according to the invention are used for radiodiagnosis, the metal must be radioactive. This can be an isotope from the series of elements Tc, In, Rh, Ga, Sc, Bi, Y, Fe, Sm, Ho, Co, Cu, Gd, and Eu.
As suitable chelating agents, the following can be mentioned by way of example:
2-(4-Ethoxybenzyl)-3,6,9-tris(carboxymethyl)-3,6,9-triazaundecane-1,11-dicarboxylic acid (ligand of Eovist(copyright), EP 405704
2-(4-benzyloxybenzyl)-3,6,9-tris(carboxymethyl)-3,6,9-triazaundecane-1,11-dicarboxylic acid, EP 405704
2-(4-butylbenzyl)-3,6,9-tris(carboxymethyl)-3,6,9-triazaundecane-1,11-dicarboxylic acid, WO 95/28179
2,5,8,11-tetrakis(carboxymethyl)-2,5,8,11-tetraazabicyclo[10,4,0]-hexadecane, U.S. Pat. No. 5,358,704
2,5,12,15-tetrakis(carboxymethyl)-2,5,12,15-tetraazatricyclo[10,4,0,06,11]-icosane, U.S. Pat. No. 5,358,704
10-[1-methyl-2-oxo-3-aza-5-oxo-5-{4-perfluorooctylsulfonyl-piperazin-1-yl}-pentyl]-1,4,7-tris(carboxymethyl)-1,4,7,10-tetraazacyclododecane, WO 97/26017
10-[2-hydroxy-4-aza-5-oxo-7-oxa-10,10,11,11,12,12,13,13,14,14,15,15,16,16,17,17,17,-heptadecafluoroheptadecyl]-1,4,7-tris(carboxymethyl)-1,4,7,10-tetraazacyclododecane, WO 97/26017
2-[1,4,7,10-tetraaza-4,7,10-tris(carboxymethyl)cyclododecan-1-yl]-3-benzyloxypropionic acid, WO 89/05802
2-benzyloxymethyl-3,6,9-tris(carboxymethyl)-3,6,9-triazaundecane-1,11-dicarboxylic acid, EP 230893
DTPA-Lys-Asp-Asp-4-pentylbicyclo[2,2,2]-octane-1-carboxylic acid, Mallinckrodt MP-2269, Vancouver SMRM, April 1997
4-[hydroxymethyl-(4,4-diphenyl)cyclohexyloxy-phosphoric acid diester]-3,6,9-carboxymethyl-3,6,9-triazaundecane-1,11-dicarboxylic acid (MS-325), WO 96/23526
4-[hydroxymethyl-(10-phenyl)-decyloxy-phosphoric acid diester]-3,6,9-carboxymethyl-3,6,9-triazaundecane-1,11-dicarboxylic acid (MS-323, WO 96/23526)
N-(4-Decylphenylcarbamoylmethyl)-diethylenetriamine-N,Nxe2x80x2,Nxe2x80x3,Nxe2x80x3-tetracetic acid, EP 603403
4,5-Diethyl-10,23-dimethyl-9,24-bis(3-hydroxypropyl)-16,17-bis[2-[2-(2-methoxyethoxy]ethoxy]-13,20,25,26,27-pentaazapentacyclo [20.2.1.]3,6.18,11.014,19]heptacosa-3,5,8,10,12,14,16,18,20,22,24-undecane. U.S. Pat. No. 5,583,220.
The production of the pharmaceutical agents is carried out in a way known in the art by the corresponding complex compoundsxe2x80x94optionally with the addition of the additives that are commonly used in galenicalsxe2x80x94being suspended or dissolved in an aqueous medium and then the suspension or solution optionally being sterilized. Suitable additives are, for example, physiologically harmless buffers (such as, for example, tromethamine), additives of complexing agents or weak complexes (such as, for example,
diethylenetriaminepentaacetic acid or the Ca complexes that correspond to the metal complexes according to the invention) orxe2x80x94if necessaryxe2x80x94electrolytes such as, for example, sodium chloride orxe2x80x94if necessaryxe2x80x94antioxidants such as, for example, ascorbic acid.
If suspensions or solutions of the agents according to the invention in water or in a physiological salt solution are desired for enteral or parenteral administration or for other purposes, they are mixed with one or more adjuvant(s) that are commonly used in galenicals [for example, methyl cellulose, lactose, mannitol] and/or surfactant(s) [for example, lecithins, Tween(copyright), Myrj(copyright)] and/or flavoring substances for taste correction [for example, ethereal oils].
In principle, it is also possible to produce the pharmaceutical agents without isolating the complexes. Special care must always be taken to perform chelation in such a way that the complexes according to the invention are virtually free of uncomplexed metal ions that have a toxic action.
This can be ensured with the aid of, for example, color indicators such as xylenol orange by control titration during the production process. The invention therefore also relates to the process for the production of complex compounds and their salts. As a final precaution, there remains purification of the isolated complex.
The pharmaceutical agents preferably contain 0.1 xcexcmol-1 mol/l of the complex and are generally dosed in amounts of 0.0001-5 mmol/kg. They are intended for enteral and parenteral administration. The complex compounds are used
1. for NMR diagnosis in the form of complexes of them with the ions of elements with atomic numbers 21-29, 42, 44 and 58-70;
2. for radiodiagnosis in the form of complexes of them with the radioisotopes of elements with atomic numbers 27, 29, 31, 32, 37-39, 43, 49, 62, 64, 70, 75 and 77.
The agents meet the varied requirements for suitability as contrast media for nuclear spin tomography. They are thus extremely well suited for improving the image, obtained with the aid of the nuclear spin tomograph, as regards its informational value after oral or parenteral administration by increasing the signal intensity. They also show the great effectiveness that is necessary to burden the body with the smallest possible amounts of foreign substances, and the good compatibility that is necessary to preserve the noninvasive nature of the studies.
The good water solubility and low osmolality of the agents make it possible to produce highly concentrated solutions, i.e., to keep the volume load on the circulation within reasonable bounds and to offset the dilution by bodily fluids. In addition, the agents have not only high stability in vitro, but also surprisingly high stability in vivo, so that release or exchange of the bonded ionsxe2x80x94which are inherently toxicxe2x80x94in the complexes occurs only extremely slowly within the time during which the contrast media are completely eliminated.
In general, the agents for use as NMR diagnostic agents are dosed in amounts of 0.0001-5 mmol/kg, preferably 0.005-0.5 mmol/kg. Owing to their advantageous radioactive properties and the good stability of the complex compounds contained therein, the agents are also suitable as radiodiagnostic agents. Details on such use and dosage are described in, e.g., xe2x80x9cRadiotracers for Medical Applications,xe2x80x9d CRC Press, Boca Raton, Fla.
In in-vivo administration of the agents, the latter can be administered together with a suitable vehicle such as, for example, serum or a physiological common salt solution or together with a protein such as, for example, human serum albumin. In this case, the dosage depends on the type of cellular disruption, the metal ion used, and the type of imaging method.
The agents are usually administered parenterally, preferably i.v. They can also be administeredxe2x80x94as already discussedxe2x80x94intravascularly or interstitially/intracutaneously.